The Pain Game: Why Pain is NEVER Where You Think It Is and What To Do

Thanksgiving is a busy day in our house.

Lots of people hustling about to prepare way too much food in way too little time.

And someone has to clean the dishes as they stack up creating a small mountain in the sink.

That someone, this year, was me.

I stood at the sink washing and washing pots, pans, baking dishes, plates, you name it – I probably washed it. Stooped over scrubbing away. For hours.

Did I hurt anywhere? Ah, maybe a bit. A bit in the lower back but I mentally waved it off like a gnat buzzing around my face.

Then, after the feast, it was back to sink, to again, scrub plates, silverware, pots and pans. It seemed endless.

I was just trying to do my part.

Two days later, I couldn’t stand up.

I had injured my back by making a rookie mistake – too much stooped over work (stooping has some of the highest stress levels on the spine).

I knew better but I lost track of time, what I was doing, and without the governor of pain, I just kept on washing those dishes.

I felt fine until I sat down the Saturday morning after Thanksgiving to do a breathing exercise that my trumpet teacher had given me. And as I tried to stand up, I had a sharp, stabbing, take- to-you-to-your-knees kind of pain.

I had to sit back down.

And then it started.

I felt the mental and emotional landslide from three years ago when I fell while snow skiing, herniated a disc, and spent the better part of a year putting myself back together, and oh, yeah, gaining about 20lbs of fat too.

At this point, I had a choice.

I could let my emotions carry me where they wanted to go or I could get in the driver’s seat and take control of the thought train.

So, I wedged myself into the driver’s seat.

How to Use Your Mind to Decrease Your Pain

This is where many people argue with me. They believe that the pain they feel comes from some specific tissue or joint or muscle or whatever. Something is injured and that something hurts.

Not true.

ALL pain is in your head.

Think about that for a minute.

Signals from the injured or diseased or damaged body parts arrive in your brain and your brain decides what to do about it.

Don’t believe me?

What about the “phantom limb” syndrome? This happens when a person loses a limb, partial or whole, to amputation and then will swear to you that the right big toe, now gone, itches like crazy. In fact, I had more than one patient in the hospital actually fall during the night because they had to pee and just got up and tried to walk to the bathroom because they still felt both legs.

Here’s what happens.

The signal runs up your spinal cord into your brain – the thalamus to be exact – and its job is to determine what to do with the info. The thalamus is part of the “lower brain” – the more primitive part. The thalamus decides where this info needs to go and most often it gets sent to the “higher brain” where the info can be evaluated. Is it a threat? Is it dangerous? Have I seen or felt this before? And of course this is all happening in in milliseconds.

You react to whatever the upper brain decides (your cerebral cortex – the thinking part of the brain; executive control center). So, in my case, because this new pain was in the same general area, had a similar quality, and more importantly, was attached to a very difficult and traumatic emotional experience, my lower brain said, “Hey, you just really messed up your back.” To which, my upper brain said, “Oh, hell. I’ve been here before. I know what this is. Not again. Not another year. Not this. I can’t handle this,” and on and on.

This happens with phenomenal speed and below your level of awareness unless you’ve learned otherwise.

So, to counteract this attack, here’s what you do:

  1. Acknowledge what you feel and feel what you feel. Don’t bury it with a distraction like alcohol, cigarettes, or whatever else you might use to numb your mind. Feel it. Be still and sit with the dis-ease. Try to be an observer of the situation. Try deconstructing what it is you’re feeling. What color would you give it? What shape? What texture? Doing this alters your perception of the information.
  2. Acknowledge your fear or anger. In addition to the actual pain, you may also have associated fears, worries, or anger, or maybe all of that. Tell it. Say it. Write it down. Talk to a trusted friend. One the worst things you can do is talk to someone who responds by dismissing what you feel as meaningless or trivial. Talk only to someone who will listen and not discount you. I actually walked around, well limped around, saying out loud, “This scares the crap out of me. I am feeling very nervous and I don’t trust what’s going to happen.”
  3. Make a plan. Most pain is a mixture of an actual physical injury and then emotional amplifiers. Make a plan to deal with both. What do you need to do to help your injured body heal, mend, and get back to the starting line ? And, what do you do to manage your mind? Well, for starters, pay attention to your feelings. Are you happy? Sad? Angry? Frustrated? See, all of these feelings stem from thoughts. The fact is I hurt. But how I react to that fact will determine how I feel about the hurt. Now, I’m not painting this as an easy thing to do. It’s not. I worked hard at reigning in my thoroughbred worry monster. But, you have to do it. So once you’ve acknowledged the fear, worry, whatever it is, you then take stock of the facts. What do you know to be true? Not what do you predict to be true. In my case, all I really knew was my back hurt and it was altering my movement. That’s it. I had no data, no facts that indicated it was anything other than that. I had nothing to suggest that what would happen would mimic what had happened in 2008. Those thoughts were all fear. So, I stopped thinking those thoughts and replaced them with, “I’m hurt. What do I need to do to get out this position and prevent anything else from happening?”
  4. Work the plan. This is maybe the most difficult part because you have to let go of any expectations (I’ll be better in a two days), continue to pay attention to your thought patterns (Why am I not better in two days?), and hold on to hope.  And, for the physical part, depending on the severity of your injury, it can take a while – sometimes months – to fully recover. And each day, you have to show up in your life, execute the plan, find something good to hold on to, and then do it again the next day.
  5. Re-assess. At some point, you need to know what’s better and what’s not. At first, there are certain things that hurt (for me it was just bending forward or walking) and you can use those functions as part of a re-test. You could also keep a journal and with just a line or two at night, note how you’re feeling, what happened over that day then after a month or so, scan back over your journal. I think you’ll be surprised at the improvements even if you still hurt. When recovery is slow, you need some history to remind you where you started.
  6. Avoid over analyzing. This is the mind game. Every little twinge begins to take on more meaning than it should. Think of it like this. Pain is a sensation. Like itching. But pain has emotion attached to it. It has some meaningful context. Do you ever get worried about an itch? So, if you feel a twinge of pain or something that causes you concern, how much has it altered your movement? Does this twinge make you limp? Over unable to comb your hair? In other words, pain that alters your function is something to sit-up and pay attention to. Otherwise, pain is just messing with your head.

What I’ve talked about here applies to musculoskeletal pain and not pain of internal organs or diseases such as certain cancers. That type of pain, although similar and requires mental and emotional energy, is a different subject.

Now, for those of you who like to dig deeper, below is an excellent overview of pain and the central nervous system.

The Pain Game – Part II - FusionPerformanceTraining - Get Your Body Armor On. says

[…] The Pain Game: Why Pain is NEVER Where You Think It Is and What To Do One Simple Change in Your Exercise Routine That Melts Fat […]

Malcolm Macaulay says

Great thoughts for refocusing energy. Sometimes difficult to explain to people that Pain in the Brain is not a put down. Mosely does a great job of explaining and I like your focused plan also.
Malcolm Macaulay, PT, OCS

DD Kelsey says

I know what you mean. Our culture frowns upon being told “it’s all in your head” even though it’s completely true. I have used the example of phantom limb as a way to explain the process of pain a number of times and have seen it work.

Lacey says

So interesting! I had a friend with RSD/CRPS. Awful. I couldn’t make heads or tails how there could be pain without a cause… it is in the head.

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